PGS

[RaisinGirls]

I am doing a bundle of 3 cycles of IVF and the intention is that we freeze the embryos and send them off for PGS. I've only managed two embryos from two cycles and am waiting to start my final cycle, where I suspect it will be one embryo again if I'm lucky. Embryos frozen at day 2 /3 so no guarantee they'll develop further.

I'm now wondering if it's worth paying 4K to send them off to get tested - suggested due to multiple MC and being 41- or if I should instead use the money for another few cycles of IVF and bump my chances through volume and just go ahead and get on wth ET without the testing.

Has anyone similar experience or dilemma or thoughts that might help me make my mind up.

[Hyland]

What is your amh level?

[RaisinGirls]

I have no idea. My consultant just recommended I did natural modified due to age and previous MCs. I think I remember him saying it was what was expected / average for someone my age

[NotSpartacus]

It is difficult. I've just done IVF and we didn't do PGS (I'm 40 and have past losses). It felt a step too far, but we put 2 blasts back in and I spent the whole 2ww on edge. I was very worried I would get pregnant and then miscarry or have to terminate for medical reasons. In the end, the BFN was easier than weeks of worry about whether any baby was ok.

I have been offered PGS on the remaining blasts before FET but think we may as well put them in and leave it up to nature. I think it unlikely that more than one of my eggs will have been normal and as I only have three left it seems ok to put 2 in and see what happens. If I did another full cycle though I would do PGS because of the worry I had during the 2ww after the fresh transfer.

Sorry, that probably doesn't help much!

[bananafish81]

We didn't do PGS on our first round and regretted it. However that's because we ended up getting more embryos than we expected. We transferred one, miscarried, but turned out the embryo was chromosomally normal and so PGS wouldn't have made any difference

We are going again for another fresh round, with the intention of doing PGS (and hopefully thawing our untested frosties for biopsy to test at the same time). For us with 4 blasts it seemed like Russian Roulette to pick which one might have been a good one (I'm 34 so wouldn't transfer two blasts) - and with low AMH we wanted to embryo bank.

The other reason was that because we miscarried a euploid embryo, we're doing everything we can to optimise the uterine environment - but if we don't transfer a PGS tested embryo and the cycle fails or I miscarry, we won't know whether it was the seed or the soil

I realise that's probably of absolutely no use whatsoever - I guess the piece of advice that stuck was that it was only worth doing if we had a decent number of blasts. Hence why I regret not doing it the first time because we did end up with 5 in total, and no way to know which were the good ones

[bananafish81]

Have you had them all biopsied at day 3 before freezing? Is there any reason why they didn't culture to blast before biopsy, as that's a self selection process in and of itself?

[RaisinGirls]

I think it's just the way the clinic does it, freeze at day 2/3.

My main concern is if I send 5/6 off for PGS and more than 2 ok, I will have to discard the extra healthy ones. I feel like maybe I should just take my luck with the embryos rather than getting to a point where healthy ones are discarded.

[bananafish81]

So they've biopsied them already and frozen them at day 2/3?

I'm 34 and I'd expect at least a 50% aneuploidy rate of blasts

Of my day 3-ers, less than half made it to blast

And I'd expect no more than half of these to be chromosomally normal

If you're biopsying at day 3 then I'd imagine you'd need to test more embryos to get a euploid one, because you're testing before the weaker ones have filtered themselves out already

In my last cycle I had 12 good embryos at day 3. However only 7 of these made it to day 5, of which 2 weren't good enough quality to freeze. So from 12 embryos we got 5 blasts

If you're freezing at day 3 then I personally wouldn't do PGS as depending on your age and expected aneuploidy rate, it could get v v expensive - our clinic charges a flat rate for biopsying 8 embryos, not sure how yours charges.

[BeedlesPineNeedles]

I'm not really sure I understand why your clinic isn't trying to get more embryos or why you would have to discard them if there were more than 2 good ones. Even if you put back a perfect embryo pregnancy unfortunately isn't guarenteed.

[RaisinGirls]

Clinic charges a flat fee for PGS - testing up to 8 at a time. The embryos would need to be thawed for the biopsy and once thawed can't be re frozen. I didn't realise this at first and thought that the embryos would stay frozen until transfer. I know it's unlikely but I didn't like the idea of wasting healthy embryos if it turned out more than two were OK. Just thinking now I would be better off doing two packages of 3 cycles instead and take my chances with regards to egg quality.

I'm on natural modified cycle as due to my age and past MC advice was not to go for quantity go for quality. I've managed 3 eggs collected each time but only managed to get one embryo each time from this.

[bananafish81]

PGS results take up to 2 weeks at my clinic - hence why cycles have to be freeze all

They used to do rush results and try fresh transfers but this wasn't successful due to missing the implantation window

I really really don't understand the point of doing PGS this way - the point of PGS is to be able to test a decent amount of embryos, to bank them so that you can transfer one at a time, and keep others on ice in case this pregnancy isn't successful or for a second child

It seems a massive risk to try PGS on thawed embryos that then can't be refrozen

I had assumed the embryos were biopsied before being frozen

I definitely wouldn't do PGS if the embryos hadn't already been biopsied

My clinic charges a flat rate for 8 embryos too. Which is why biopsying at day 3 would have been crazy. If we had done PGS on our first round we'd have biopsied 12 embryos. When we know 7 of those were duds that didn't make it to decent blast. We'd have tested embryos that didn't need to be tested

Based on
A) not having biopsied before freezing
B) doing day 3 biopsies
C) not having large amounts for testing

I definitely wouldn't do PGS if I were in your shoes

[RaisinGirls]

Thanks . Really helpful to have your perspective. I think when a clinic has a set way of doing things they just explain that process. At first you just accept it but then once you get s feel for things you do start to think differently, question things and work out whether something is for me or not

[bananafish81]

Good luck RaisinGirls

I'm just miffed that the clinic didn't explain the rationale for their PGS process - it seems bonkers to me, but I'm sure they have their reasons - I'm just not sure what they are!

Do they have a well established genetics programme? I only ask because PGS is moving so quickly that clinics are gathering new data the whole time

My clinic has a very very well established genetics programme, and whereas 2 months ago they said they wouldn't recommend thawing our untested blasts for biopsy (and then refreezing them while the results are sent off, and thawing one for transfer) - now 2 months later they have new data to suggest this may be reasonable

I am planning to discuss this with my consultant at my first tracking scan for this cycle tomorrow. I'd like to understand how much experience they've had with this and what % risk of freeze / thaw damage they'd expect. There's little point testing them to find out there's one euploid blast and for it then to fail to survive the thaw!

Will see what they say - will also very much depend on how many blasts we get this time. So much of PGS is a numbers game!

[BeedlesPineNeedles]

It does seem an odd way to do it. I was part of a PGS study during my 4th IVF cycle. But they wanted to get a good number of embryos, so if at least 5 were fertilised they would continue to day 5, biopsy any blasts at day5/6 then freeze them all to return in a later cycle.

I had 4 good blasts on day 5 (but was in the control group so no pgs). This was at nearly 40. My previous 3 cycles had resulted in 2 OK embryos, 3 good and 4 good -all day 2 transfers. And from these I got pregnant once and mc at 6 weeks.

Maybe you could ask if it's worth trying to get more embryos in your 3rd cycle and biopsy them at day 5 and then freeze.

[bananafish81]

They also recommend biopsy at day 5 because you can take several cells from the trophoctoderm of a blastocyst, vs a single cell from a day 3 embryo

[bananafish81]

BTW just to update on PGS

We had our 4 frozen blasts thawed, all four survived the thaw but only 3 re expanded and progressed to hatching blast stage to be suitable for biopsy. The fourth thawed but didn't re expand and progress so therefore wasn't able to biopsied. It's likely this embryo was aneuploid so probably weeded itself out

We also had 9 fresh blasts from the fresh cycle biopsied and frozen

The results will take 2 weeks to turnaround

It would have been possible to biopsy at day 3 for 24h turnaround and transfer on day 5, but the lab didn't recommend this.

[AmyK18]

Banafish- what were your results we are doing this next week I am very nervous they will all come back abnormal. Sorry I realise this was a couple of years ago for You now!

[bananafish81]

Hiya

Our frosties were all abnormal

Of the 9 fresh that were biopsied, 6 were normal

I miscarried another normal and we have 5 normals left on ice

Drs on both sides of the Atlantic have confirmed that my particular issues mean my uterus is too damaged to sustain a pregnancy so the only way we will be able to turn any of our embryos into a person would be via surrogacy

Good luck with your results